Provider Demographics
NPI:1164580890
Name:CANYON VIEW MEDICAL GROUP LLC
Entity Type:Organization
Organization Name:CANYON VIEW MEDICAL GROUP LLC
Other - Org Name:SANTAQUIN MEDICAL C LINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:AARON
Authorized Official - Middle Name:
Authorized Official - Last Name:LOWE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:801-798-7301
Mailing Address - Street 1:325 W CENTER ST
Mailing Address - Street 2:
Mailing Address - City:SPANISH FORK
Mailing Address - State:UT
Mailing Address - Zip Code:84660-2060
Mailing Address - Country:US
Mailing Address - Phone:801-798-7301
Mailing Address - Fax:801-798-8513
Practice Address - Street 1:94 W MAIN ST
Practice Address - Street 2:
Practice Address - City:SANTAQUIN
Practice Address - State:UT
Practice Address - Zip Code:84655
Practice Address - Country:US
Practice Address - Phone:801-754-3122
Practice Address - Fax:801-754-0197
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-05
Last Update Date:2023-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
UTCE7334OtherRAIL ROAD MEDICARE
UTCE7334OtherRAIL ROAD MEDICARE
UT=========OtherTAX ID
UT=========001Medicaid
UT1172630001Medicare NSC